Drug for treatment of gastric and duodenal peptic ulcer disease

ABSTRACT

A composition for the treatment of gastric and duodenal peptic ulcer disease which is a combination of trapencaine and rantidine is disclosed.

The invention concerns a drug acting on gastric and duodenal peptic ulcers. Its effective component is the combination of a gastroprotective and antiulcer drug with specific effect against Campylobacter pylori and of a typical representative of antisecretory drugs, belonging to H₂ antagonists. The efficacy of the combination is significantly greater than the effect of each drug administered separately.

The mechanism of antiulcer action is characteristic of each drug used for the treatment of gastric and duodenal peptic ulcer disease. The drugs inhibiting gastric acid secretion which are available so far, such as antagonists of histamine H₂ receptors e.g. cimetidine, renitidine, mifentidine (P. Del Soldato et al., Pharmacology 30, 45 (1985), Brimblecombe R. W. et al., Gastroenterology 74, 339 (1987), Daly M. et al., Br. J. Pharmacol. 72, 49 (1981) lack gastric cytoprotective effect as well as antimicrobial activity against Campylobacter pylori, a microorganism which has been reported to influence directly the development of gastric ulcers and thus to be a possible therapeutic target (Mc Nulty, J. Antimicrob. Chemother. 19, 281 (1987) ). Inhibitors of H, K-ATP ase and bismuth salts have been used in the therapy of peptic ulcer disease (A. Garner: Advances in Drug Therapy of Gastro-Intestinal Ulceration, J. Wiley et Sons Ltd., Chichester, W. Sussex, 1989) as well as anticids and prostaglandins (Ishihava K., Digestion 39, 162 (1988).

None of the above mentioned drugs possesses all types of the given antiulcer effects and after therapy withdrawal there is a high relapse rate especially when drugs such as H₂ antagonists are used; further problems are the cumulation of the drug in the organism (bismuth salts) and a spectrum of undesirable side effects or toxic effects (prostaglandins and others). Some of these disadvantages or shortcomings can be avoided by the combination of drugs according to the invention with the effective components /±/-trans-2-/1-pyrrolidinyl/cyklohexylester of 3-/n/pentyloxycarbanilic acid (international term trapencaine) formula I ##STR1## and N-/2-//5/dimethylamine/methyl/furfuryl/thio/ethyl-N'-methyl-2-nitro-1,1-ethendiamine (approved international term ranitidine) formula II ##STR2## or their salts with pharmaceutically acceptable acids (weight ratio 3:10 up to 10:3) which may contain a physiologically harmless vehiculum.

The combined treatment had a profound effect both on acute gastric lesions induced by the nonsteroidal antiinflammatory drug phenylbutazone in a dose of 200 mg/kg p.o. in rats and on gastric lesions induced by restraint stress with water bath immersion, as expressed by the reduction of lesion length or by the inhibition of lesion development.

On studying the dose-response relationship of the separately administered drugs trapencaine and ranitidine, an effective inhibition of the gastric damage was observed (Tab. 1, 2).

                  TABLE 1                                                          ______________________________________                                         Effect of ranitidine administered orally in doses                              of 1, 3, 10 and 30 mg · kg.sup.-1 on the length and number            of gastric lesions induced by phenylbutazone in rats                                   dose                       %                                           treatment                                                                              mg · kg.sup.-1 p.o.                                                               n     - x ± SEM                                                                            inhibition                                                                            p                                    ______________________________________                                                                   lesion length                                        control 5 ml · kg.sup.-1                                                                  20    55.50 ± 5.64                                                                         --     --                                   (H.sub.2 O)                                                                    ranitidine                                                                              1          10    43.05 ± 10.77                                                                        22.43  n s                                  ranitidine                                                                              3          10    18.80 ± 7.56                                                                         66.13  0.01                                 ranitidine                                                                             10          10    0.25 ± 0.17                                                                          99.55  0.01                                 ranitidine                                                                             30          10    0.00 ± 0.00                                                                          100.00 0.01                                                           lesion number                                        control 5 ml · kg.sup.-1                                                                  20    22.75 ± 2.01                                                                         --     --                                   (H.sub.2 O)                                                                    ranitidine                                                                              1          10    19.65 ± 3.94                                                                         13.63  n s                                  ranitidine                                                                              3          10    10.20 ± 3.58                                                                         55.17  0.01                                 ranitidine                                                                             10          10    0.20 ± 0.13                                                                          99.12  0.01                                 ranitidine                                                                             30          10    0.00 ± 0.00                                                                          100.00 0.01                                 ______________________________________                                          n s = nonsignificant                                                           p versus control                                                         

On using the combination of low ineffective doses of each drug (10 mg/kg trapencaine and 3 mg/kg ranitidine) an approximately 90% inhibition of gastric damage was recorded (Tab. 3).

Individual intraduodenal administration of 10 mg/kg trapencaine or 5 mg/kg ranitidine failed to exert antisecretory effect with regard to volume of gastric juice, acidity or total acid output, whereas their combined treatment profoundly inhibited all parameters tested (Tab. 4).

                  TABLE 2                                                          ______________________________________                                         Effect of trapencaine administered orally in doses                             of 1, 3, 10 and 30 mg · kg.sup.-1 on the length and number            of gastric lesions induced by phenylbutazone in rats                                   dose                       %                                           treatment                                                                              mg · kg.sup.-1 p.o.                                                               n     - x ± SEM                                                                            inhibition                                                                            p                                    ______________________________________                                                                   lesion length                                        control 5 ml · kg.sup.-1                                                                  18    57.81 ± 6.15                                                                         --     --                                   (H.sub.2 O)                                                                    trapencaine                                                                             1          10    48.65 ± 9.76                                                                         15.84  n s                                  trapencaine                                                                             3           8    37.87 ± 9.25                                                                         34.48  n s                                  trapencaine                                                                            10           8    18.69 ± 9.07                                                                         67.67  0.01                                 trapencaine                                                                            30           8     0.06 ± 0.06                                                                         99.89  0.01                                                           lesion number                                        control 5 ml · kg.sup.-1                                                                  18    22.47 ± 1.84                                                                         --     --                                   (H.sub.2 O)                                                                    trapencaine                                                                             1          10    20.35 ± 3.90                                                                         9.44   n s                                  trapencaine                                                                             3           8    15.81 ± 2.55                                                                         29.64  n s                                  trapencaine                                                                            10           8     6.56 ± 2.78                                                                         70.80  0.01                                 trapencaine                                                                            30           8     0.06 ± 0.06                                                                         99.72  0.01                                 ______________________________________                                    

                  TABLE 3                                                          ______________________________________                                         Effect of ranitidine administered in the dose of 3 mg/kg,                      trapencaine in the dose of 10 mg/kg and their combination                      on the length and number of gastric lesions induced by                         phenylbutazone in rats                                                                    dose                     %                                                     mg · kg.sup.-1  inhi-                                      treatment  p.o.      n              bition                                                                               p                                    ______________________________________                                                                      lesion length                                     1/  control    5 ml · kg.sup.-1                                                                10  51.00 ± 12.09                                                                        --    --                                     (H.sub.2 O)                                                                2/  ranitidine  3        10  31.40 ± 9.13                                                                         38.43 n s                                3/  trapencaine                                                                               10        10  17.60 ± 7.95                                                                         65.49 0.05                               4/  ranitidine +                                                                              3 + 10    10  4.70 ± 3.28                                                                          90.78 0.01                                   trapencaine                                                                                             lesion number                                     1/  control    5 ml · kg.sup.-1                                                                10  21.80 ± 3.80                                                                         --    --                                     (H.sub.2 O)                                                                2/  ranitidine  3        10  13.65 ± 3.26                                                                         37.39 n s                                3/  trapencaine                                                                               10        10  7.05 ± 2.34                                                                          67.66 0.01                               4/  ranitidine +                                                                              3 + 10    10  2.45 ± 1.29                                                                          88.76 0.01                                   trapencaine                                                                ______________________________________                                          2:4 p < 0.01                                                             

                                      TABLE 4                                      __________________________________________________________________________     Effect of trapencaine in the dose of 10 mg · kg.sup.-1 and            ranitidine in the dose of 5 mg · kg.sup.-1 and their combi-           nation administered intraduodenally on gastric acid                            secretion stimulated by histamine in rats                                                                          total acid                                         dose     volume    acidity  output/umol.                               treatment                                                                              mg · kg.sup.-1 i.d.                                                          n ml · 100 g.sup.-1                                                            %  mmol · l.sup.-1                                                             %  100 g.sup.-1                                                                          %                                   __________________________________________________________________________     control 5 ml · kg.sup.-1                                                             11                                                                               4.8 ± 0.3                                                                          -- 100.1 ± 4.6                                                                       -- 480.9 ± 41.9                                                                       --                                  trapencaine                                                                            10     10                                                                               4.6 ± 0.4                                                                          3.6                                                                               93.0 ± 5.8                                                                        7.1                                                                               416.5 ± 48.5                                                                       13.4                                ranitidine                                                                              5     11                                                                               4.3 ± 0.2                                                                          10.3                                                                              96.4 ± 1.7                                                                        3.7                                                                               413.3 ± 25.9                                                                       14.0                                trapencaine +                                                                          10 + 5 11                                                                               1.3 ± 0.2                                                                          72.5.sup.+                                                                        50.1 ± 4.9                                                                        50.0.sup.+                                                                         73.4 ± 14.1                                                                       84.7                                ranitidine                                                                     __________________________________________________________________________

values are expressed as mean±SEM and percentage of inhibition+p versus control<0.001

Oral administration of 20 mg/kg trapencaine or of 10 mg/kg ranitidine was not effective when the drugs were administered separately, whereas the drug combination in the same doses influenced significantly gastric acid secration, expressed as percentage of inhibition (Tab. 5).

                                      TABLE 5                                      __________________________________________________________________________     Effect of trapencaine in the dose of 20 mg · kg.sup.-1, rani-         tidine in the dose of 10 mg · kg.sup.-1 and their combination         administered orally on gastric acid secretion stimulated                       by histamine in rats                                                                                                total acid                                        dose      volume    acidity  output/umol.                              treatment                                                                              mg · kg.sup.-1 p.o.                                                           n ml · 100 g.sup.-1                                                            %  mmol · l.sup.-1                                                             %  100 g.sup.-1                                                                          %                                  __________________________________________________________________________     control 5 ml · kg.sup.-1                                                              13                                                                               5.1 ± 0.2                                                                          -- 99.9 ± 2.9                                                                        -- 516.3 ± 29.6                                                                       --                                 trapencaine                                                                            20      14                                                                               4.6 ± 0.3                                                                          9.0                                                                               92.4 ± 3.7                                                                        7.5                                                                               438.5 ± 37.5                                                                       15.1                               ranitidine                                                                             10      14                                                                               4.5 ± 0.1                                                                          11.9.sup.+                                                                        96.4 ± 2.4                                                                        3.5                                                                               434.2 ± 18.8                                                                       15.9                               trapencaine +                                                                          20 + 10 14                                                                               3.3 ± 0.2                                                                          36.2.sup.+                                                                        78.4 ± 3.6                                                                        21.5.sup. +                                                                       263.5 ± 26.5                                                                       49.0                               ranitidine                                                                     __________________________________________________________________________

values are expressed as mean±SEM and percentage of inhibition+p versus control<0.05

On using low oral doses of separately given drugs there was a smaller inhibition of gastric secretion and again after the combined treatment a significant inhibition of volume, acidity and total acid output was achieved.

Experimentally induced chronic gastric ulcers were not significantly affected when doses of 30 mg/kg p.o. of each separately administered drug were used, while the combined treatment increased efficacy in reducing the ulcer area by 81% (Tab. 6).

Antiuloer efficacy of the combined trapencaine and ranitidine treatment is more pronounced than the effect of each drug given alone. The resulting antiulcer activity appears to be additive, in some cases synergistic. The drug according to formula I can be prepared on the basis of the Czechoslovak patents No. 125666 and No. 126102, the drug according to formula II is available from the producer.

                                      TABLE 6                                      __________________________________________________________________________     Extent of ulcer area 7 days after chronic gastric                              ulcer production in control (untreated) group and                              in the groups given ranitidine in the dose of 30                               mg · kg.sup.-1 p.o. twice daily, trapencaine in the dose              of 30 mg · kg.sup.-1 p.o. twice daily or their combination                    dose        ulcer area (mm.sup.2)                                                                   %                                                 treatment                                                                              2 × mg · kg.sup.-1 p.o.                                                   n - x ± SEM                                                                            inhibition                                                                          p                                            __________________________________________________________________________     control (H.sub.2 O)                                                                    5 ml · kg.sup.-1                                                                11                                                                               22.06 ± 4.02                                                                         --   --                                           ranitidine                                                                             30        11                                                                                8.98 ± 5.01                                                                         59.27                                                                               n s                                          trapencaine                                                                            30        11                                                                               15.98 ± 5.34                                                                         27.54                                                                               n s                                          ranitidine +                                                                           30 + 30   10                                                                                4.09 ± 2.06                                                                         81.48                                                                               0.01                                         trapencaine                                                                    __________________________________________________________________________

EXAMPLE

Tablet form of the antiulcer drug

Effective substances in the amount of 20 g trapencaine and 10 g ranitidine are mixed with 40 g lactose, 135 g starch and moistened with the necessary amount of starch hydrogel. The mixture is granulated, homogenised and 2 g of magnesium stearate is added.

The mixture is pressed into tablet form of approximately 250 mg, with a diameter of 5 mm. One tablet corresponds to the combined dose of 30 mg effective substances (20 mg trapencaine and 10 mg ranitidine). 

We claim:
 1. A drug composition for the treatment of gastric and duodenal peptic ulcer disease comprising as effective components the combination of /±/-trans-2/1-pyrrolidinyl/cyklohexylester of 3-/n/-pentyloxycarbanilic acid formula I ##STR3## and N/2-/5-/dimethylamine/-methyl/furfuryl/thio/ethyl-N'-methyl-2-nitro-1,1-ethendiamine formula II ##STR4## or their salts with pharmaceutically acceptable acids with the weight ratio of 3:10 up to 10:3, which may contain physiologically harmless vehicle.
 2. The drug composition according to claim 1 further comprising a physiologically harmless vehicle.
 3. A method of treating gastric and duodenal peptic ulcer disease comprising administering an effective amount of the drug composition of claim 1 to a patient in need thereof, wherein said drug composition is orally administered. 